29 Menstrual Disorders/Suppression Besinque Flashcards Preview

What are some characteristics of a normal menstrual cycle?

Menstruation lasts on average of 4-7 days. Average blood loss is 35 mL. 90% of menstrual blood loss is completed by the end of the third day. Chronic menstrual blood loss > 80 mL per cycle leads to anemia

What hormonal therapy can be used for heavy menstrual bleeding?

What non-hormonal therapy can be used for heavy menstrual bleeding?

NSAIDs. Tranexamic acid (Lysteda). These can be used in combo with hormonal therapy

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What surgical therapy can be used for heavy menstrual bleeding?

Endometerial ablation. Hysterectomy

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What is Tranexamic Acid (Lysteda)?

An antifibrinolytic drug for heavy menstrual bleeding. Synthetic amino acid derivative that prevents binding of fibrin and plasmin in a reversible manner, which helps prevent the breakdown of blood clots

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How is Tranexamic Acid (Lysteda) dosed?

1,300mg (2 tablets) three times a day for a maximum of five days during menstruation. Requires adjustment for renal function

What are the ADRs associated with Tranexamic Acid (Lysteda)?

When should Tranexamic Acid (Lysteda) not be used?

Women taking COC. History of blood clots

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How does the Levonorgestrel Intrauterine system for DUB work?

Releases 20 ug of levonorgestrel every 24 hours. Decreases amount of menstrual blood loss. Used to treat heavy bleeding. Consider a bleeding disorder to be present if the patient is unresponsive to treatment

What nutritional supplements have been studied and shown to work?

Calcium carbonate with vitamin D. Magnesium, up to 500 mg per day. Vitamin B-6 and vitamin E have not been studied as much, but may work

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What pharmacologic therapy has been shown to help with PMS/PMDD?

SSRIs. Can actually be effective if just taken during luteal cycle (7-14 days)

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How can Diuretics help with PMS treatment?

Diuretics for fluid retention and bloating are effective. Spironolactone is preferred, in addition to being a diuretic it also interferes with testosterone synthesis. May treat other symptoms of PMS as a result. Dose 50-100mg/day during luteal phase

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What are three treatment strategies to eliminate or decrease hormone-free intervals with OCs in the treatment of PMS/PMDD?

How can evening primrose oil help?

Helps with breast tenderness/pain

What should be done when PMS/PMDD symptoms are occurring outside of the luteal phase?

Refer

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What is Endometriosis?

Growth of endometrial cells outside uterus. Most commonly found: on ovaries, on exterior of uterus, on bowel, on bladder, within abdominal cavity

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What is the prevalence of endometriosis?

15-25% of all female surgical patients have endometriosis. 30-40% of women with endometriosis experience fertility problems. 20% of infertile women are diagnosed with endometriosis

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What is the etiology of Endometriosis?

Blood and endometrial cells back up through uterus and tubes and implant or attach to other sites. May have genetic contributions

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What are the key components in the development of endometriosis?

Local overproduction of prostaglandins by an increase in COX-2 activity and overproduction of local estrogen by increased aromatase activity. Progesterone resistance dampens the anti-estrogenic effect of progesterone and amplifies the local estrogenic effect

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What is the presentation of endometriosis?

May be asymptomatic. Endometrial implants respond to hormone level fluctuation similar to normal endometrial lining and may bleed during menstruation. Endometriomas (chocolate cysts) may form. Usually reaches maximum severity in 30-40s. Pain throughout cycle, with menses or intercourse (severity of pain does not correlate with severity of disease - might correlate with depth of lesions). Lower abdominal cramps. Heavy and/or irregular periods. Rectal pain with defecation. Urinary discomfort. Infertility